Implantable Cardioverter-Defibrillators Re-Examined

Clinical trial evidence supports their usage based on treatment guidelines

By Sridhar Nadamuni

HealthDay Reporter

THURSDAY, Sept. 25 (HealthDay News) -- There is a compelling rationale for clinicians to critically analyze evidence-based guidelines when using implantable cardioverter-defibrillators (ICDs) for the prevention of sudden cardiac death, according to a report published in the Sept. 30 issue of the Journal of the American College of Cardiology.

In a critical appraisal, Roderick Tung, M.D., of Beth Israel Deaconess Medical Center in Boston, and colleagues reviewed scientific literature for the benefits and potential hazards of ICD therapy.

The findings suggest that the efficacy of ICD therapy has been overestimated in clinical trials while the cost of therapy as well as adverse effects have been ignored. The authors associate ICDs with morbidity and poor quality of life due to infection, shocks, potential for inducing arrhythmia, device malfunction and procedural complications. Nonetheless, multiple trials have generated consistent results over more than 10 years with a 20 to 30 percent reduction in total mortality and improved survival in patients with left ventricular dysfunction, according to an accompanying commentary by Andrew E. Epstein, M.D., of the University of Alabama at Birmingham.

"Although we all freely admit that there are problems with ICDs, the weight of evidence supports their use for the indications listed in appropriate patients," based on the 2008 Device-Based Therapy Guidelines, Epstein writes.